Eyes, Episcleritis and Scleritis

Episcleritis and scleritis usually present as a localised area of inflammation. The episclera lies just beneath the conjunctiva and adjacent to the tough white scleral coat of the eye. Both the sclera and episclera may become inflamed, particularly in rheumatoid arthritis and other autoimmune conditions, but no cause is found for most cases of episcleritis.

The patient complains of a red and sore eye that may also be tender. There may be reflex lacrimation but usually there is no discharge. Scleritis is much more painful than episcleritis. The pain of scleritis often is sufficiently severe to wake the patient at night.

There is a localised area of inflammation that is tender to the touch. The episcleral and scleral vessels are larger than the conjunctival vessels. The signs of inflammation are usually more florid in scleritis.

Any underlying cause should be identified. Episcleritis is essentially self limiting, but steroid eye drops hasten recovery and provide symptomatic relief. Scleritis is much more serious, and all patients need ophthalmological review. Serious systemic disorders need to be excluded, and
systemic immunosuppressive treatment may be required.

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Red Eye

The “red eye” is one of the most common ophthalmic problems presenting to the general practitioner. An accurate history is important and should pay particular attention to
vision, degree, and type of discomfort and the presence of a discharge. The history, and a good examination, will usually permit the diagnosis to be made without specialist ophthalmic
equipment.

Symptoms and signs

The most important symptoms are pain and visual loss; these suggest serious conditions such as corneal ulceration, iritis, and acute glaucoma. A purulent discharge suggests bacterial
conjunctivitis; a clear discharge suggests a viral or allergic cause. A gritty sensation is common in conjunctivitis, but a foreign body must be excluded, particularly if only one eye is
affected. Itching is a common symptom in allergic eye disease, blepharitis, and topical drop hypersensitivity.

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